Finding Advanced Cancer

Some cancers are more likely to spread than others. But it’s hard to know who will develop advanced cancer. Advanced cancers are those that have spread from where they first started and are no longer responding to treatment. Here are some of the ways that advanced cancer may be found.

Signs and symptoms of advanced cancer

General signs and symptoms of advanced cancer can include:

Loss of energy and feeling tired and/or weak: This can get so bad that you may have a hard time doing everyday tasks like bathing or getting dressed. People with advanced cancer often need help with these things. At some point, they may need to spend most of their time in bed. (It’s important to note that some cancer treatments can cause this symptom, too.)

Weight loss (without trying)

Pain

Shortness of breath or trouble breathing

Advanced cancers can also cause many other symptoms, depending on the type of cancer and where it has spread.

Physical exam

Along with asking about your symptoms, a lot can be learned by examining you. Your health care provider may find signs of problems caused by advanced cancer, such as:

Fluid in your lungs

Fluid in your belly (abdominal cavity)

Lumps (tumors) on or within your body

An enlarged liver

Weakness or numbness in your legs

Tests to find advanced cancer

Blood tests

Certain blood tests can point to advanced cancer. For instance, liver function tests are often abnormal if cancer has spread to the liver. High blood calcium levels can mean that the cancer has spread to bones.

Tumor markers: Some types of cancer cause substances in the blood called tumor markers to rise. Examples of tumor markers are PSA (prostate-specific antigen) for prostate cancer and CEA (carcinoembryonic antigen) for colon cancer. The level of these substances in the blood can sometimes be very high in advanced cancer. High levels of tumor markers can lead your doctor to suspect that cancer has come back or spread, but more testing will be needed to confirm this.

There are other tumor markers for other cancers. See our information on the specific type of cancer to learn what tumor markers may be used for it.

Imaging tests

Imaging tests take pictures of the inside of your body. Many of the tests used to find advanced cancer may have also been done when you were first diagnosed with cancer. You can learn more about these and other imaging tests your provider may want you to have by calling us or visiting our web page on imaging tests.

Looking for cancer cells in body tissues and/or fluids

Biopsy

When an imaging test finds something that isn’t normal, more tests will be needed to make sure that it’s cancer. This can often be done by taking out a small piece of the changed area and looking at it under the microscope to see if there are cancer cells in it. This is called a biopsy.

Bone marrow aspiration and biopsy

Bone marrow is the spongy tissue inside bone that makes new blood cells. If it is suspected that your cancer has spread to the bone marrow, samples of the bone marrow will need to be taken for testing.

Most often, the samples are taken from the back of the pelvic (hip) bone while you lie on a table (either on your side or on your belly). Your provider will clean the skin over your hip and then numb the area and the surface of the bone with a local anesthetic (numbing medicine). This may cause a brief stinging or burning sensation.

For aspiration, a long, hollow needle is then pushed into the bone and a syringe is used to suck out a small amount of liquid bone marrow (about 1 teaspoon). Even with an anesthetic, most patients still have some pain when this is done.

A small piece of bone and marrow (about 1/16th inch in diameter and ½ inch long) is also taken out with a slightly larger needle. This causes a feeling of pressure, and may also cause some brief pain. Once the biopsy is done, pressure will be applied to the site to help prevent bleeding.

Lumbar puncture (spinal tap)

If your provider suspects that cancer has spread to the fluid that surrounds the brain and spinal cord, they’ll need to take out some of the fluid to check it for cancer cells. Most often this is done with a test called a lumbar puncture (spinal tap). (The fluid around the brain and spinal cord is called cerebrospinal fluid or CSF.)

Most often for this test, you lie on your side with your knees pulled up to your chest. (Less often this test is done with the patient sitting up and bent over a table.) A small needle is used to numb an area in your lower back at your spine. A thin, hollow needle is then placed between the bones of the spine and into the area around the spinal cord. Some of this fluid is then collected as it drips out through the needle. The fluid is sent to a lab to be checked for cancer cells. Other tests may be done on the fluid as well.

Paracentesis and thoracentesis

If fluid has built up in the belly or abdominal cavity (called ascites) or the space around the lungs (called pleural effusion), it can be removed using a needle and sent to the lab to look for cancer cells. A local anesthetic (numbing medicine) is given to numb the area before the needle is put in. Sometimes ultrasound (an imaging test) is used to help place the needle into the area of fluid. Only a small amount of fluid is needed to test for cancer cells, but much larger amounts can be removed to help the patient feel better. Paracentesis is the test used to collect fluid in the abdomen and thoracentesis is used to collect fluid around the lungs.

What should you ask your doctor about advanced cancer?

It’s important to have open and honest talks with your doctor. Your doctor and the rest of your cancer care team want to answer all of your questions and help you make decisions that are best for you. It may help to have a family member and or a friend with you during these talks. Take notes or ask if you can record the conversation.

Here are some questions you may want to ask:

Why do you think I have advanced cancer?

How do you know that this is the same cancer I had before and not a new cancer?